New Diabetic - starting keto

(Maria Cruz) #1

Hi guys,

My hubby is a type 2 diabetic - i am completely nervous about him doing keto. He started on Monday this week and his sugars are down already. My nervous point is that his ketones have risen to 3.5. - shall i keep him on keto and ride it out or shall i increase his carbs to 60g as opposed to 50g ?

Please can someone help - wrecking my brain about this.


(Alec) #2


  1. 3.5 ketone level is just fine. He can continue doing keto no problems.
  2. If his ketones go above 10, then you should worry about ketoacidosis, and he should be at the Dr. Can others pls comment on this: this is my understanding, but i would like others opinions on this.
  3. Has he discussed his going on keto with his doctor? If he hasn’t he should.
  4. What meds is he using? If he is using insulin, he needs to be managing doses very carefully ie downwards as the need for insulin will be decreasing (possibly dramatically)

Pls take care with this. Diet can be very powerful, especially if mixed with drugs. Too high insulin with no carb intake can drive blood sugar levels too low.


Why is that an issue? If you’re afraid of DKA, that’s very rare for type 2 diabetics, because the cause is an exhaustion of insulin in the blood stream. Ketosis is caused by a restriction of carbohydrates. Insulin is more or less the “turn-off” switch, to tell the liver to stop producing ketones (and glucose).

Before keto, I had an A1c of 7.3 while using both insulin and metformin. Since starting keto nearly 5 years ago, I no longer use T2D medications and my A1c has been as low as 4.8 without them. I was able to stop insulin immediately and weaned off the metformin months later.

The “tl;dr” from the article:

Ketosis and diabetic ketoacidosis (DKA) are not the same thing. While ketosis is triggered through an extended lack of dietary carbohydrate, DKA is triggered by the exhaustion of insulin in the blood; the consequence of which is the liver over-producing fuel for the body, including ketones which, when they accumulate, can turn the blood acidic and lead to death.

Note that there are three types of ketone bodies the body produces. DKA is usually from the first one that is produced (the emergency type), which is why type 1 diabetics look for an excess of them in the urine:

(Maria Cruz) #4

He takes metaformin(daily) and an injection once a week - He hasnt spoken to the dr about it. He is talking to them today. His sugar level was 8.0 this morning and that was a record on its own. YEsterday it was 11. He is aware that he should test and decrease meds intake.

(Take time to smell the bacon) #5

Given, as the title of your thread indicates, your husband is a newly diagnosed Type II diabetic, his pancreas is still producing quite a bit of insulin, so diabetic ketoacidosis is not a concern. Diabetic ketoacidosis is a concern only when the pancreas has stopped secreting insulin.

A serum β-hydroxybutyrate level of 3.5 is at the high end of the range for nutritional ketosis, and barely into the range commonly seen during fasting. The medical advice is to start worrying about ketones at 10.0, but that is primarily to give Type I diabetics time to get to the hospital—symptoms don’t even begin until β-hydroxybutyrate reaches 20.0 mmol/L. And in diabetic ketoacidosis, the serum glucose is equally out of control, which is not the case with your husband.

(Michael - When reality fails to meet expectations, the problem is not reality.) #6

I’ll let others more competent/experienced continue to address diabetic issues specifically. I do know ketosis/ketones better. Your husband is not going to hurt himself eating keto. In fact, it’s probably the best thing he will ever do for himself. There are many folks on this forum who have reversed T2D and eliminated all medications by eating keto. It works and it’s healthy. In my opinion ketosis is the normal metabolic state for humans to live in. This based primarily on our evolution during which for several million years our ancestors had very little edible carbohydrates to eat because very few even existed. It has only been since the advent of the Holocene and the so-called agricultural revolution that humans have had the possibility to eat lots of carb foods. Elevated blood glucose and insulin are the results of doing so. Those in turn result in wrecking our metabolism and body over time. There’s lots of very good scientific evidence to support this point of view.

I’m currently celebrating my ketoversary of 5 consecutive years in continuous ketosis. Don’t worry about ketones. They take care of themselves. Keep carbs below 20 grams per day, and the lower the better. Do not fear protein and fat. Best wishes.

(Marianne) #7

I appreciate your knowledge base, Paul. I’m sure the scientific differentiations between keto and DKA were a relief to @Maria_Cruz.

(Marianne) #8

You guys are the best.

Awesome! :hugs:

(Marianne) #9

It doesn’t help that there is so much misinformation about this way of eating that can make us fearful. At almost every turn, we are told that keto is unhealthy and unsustainable. My doctors do not support my way of eating, but I take their comments with a grain of salt. Your husband my find the same if/when he consults with his doctor, depending on how well informed his physician is. Whenever I have concerns, I bring them to this forum. There are many individuals here who have a true passion for this way of eating and knowing the science around most everything related to it. I learn from them and appreciate their knowledge base.

I’ve been on clean keto just shy of three years. I’ve lost 75 lbs. but gained so many additional health benefits besides weight loss and appearance. My muscles and joints don’t hurt anymore. All the inflammation in my body is gone. My skin is better. (No lie, my husband’s fungal toenail that he’s had for over forty years completely went away and is beautiful and normal now.) Before keto, I used to walk like an old woman because my legs would hurt so badly. My knee would go right out from under me with no warning and it would almost take me down. People would ask me all the time if I was okay. Thirty years ago, I torn a groin muscle and it would flare often. Debilitating. I also had a fatty liver and A-fib; all of these things have resolved. More benefits than I can count, and the most amazing thing to me is that they are all due to my optimal internal health.

My advice; read a lot on this forum and post your questions and comments here. Scores of people are here to help and encourage. If your husband eats clean keto for a month or so, I suspect his T2D will resolve and he will feel better than he has in years. I agree that he should strive to eat less than 20 grams of carbs per day.

Good luck.

(UsedToBeT2D) #10

No worries. Celebrate. What will you do with the extra money not spent for insulin medication?

(Take time to smell the bacon) #11

There’s that famous green, yellow, and red graph by Phinney and Volek. If I can find it, I’ll post it.

ETA: Here it is

(Maria Cruz) #12

Morning guys,

Any ideas on how to deal with a nausea on keto ?


(Alec) #13

That was the chart I was remembering when I quoted the over 10 number bordering into ketoacidosis territory.

I don’t remember anyone reporting a measured ketone level above 10 on these forums before, even on extreme fasts. Does anyone remember anyone having done so? I think you may have to be quite ill to get that level, hence the need for a Dr quick if you get there.

(Take time to smell the bacon) #14

Can’t find it now, but there’s a video of Dr. Phinney leading a workshop on keto eating at one of the Low Carb Down Under events a couple of years ago, in which he asks people for the highest readings people have gotten. I swear there was one guy who said 12- or 14-something, and Dr. Phinney didn’t seem particularly concerned. What he did say was that (a) while doctors start getting worried at 10.0, symptoms are not noticeable until 20.0, and (b) if the pancreas is producing insulin, diabetic ketoacidosis is not a concern.

(Alec) #15

Is quoting ketone levels at a low carb conference a bit like anglers telling their fishing mates how big the last fish was they caught? :joy:

I think I would be rocking up to the dr regardless if I had a measured ketone level above 10.

(Michael - When reality fails to meet expectations, the problem is not reality.) #16

Yes, indeed! We’d all be wondering how you managed to do it. Be prepared to document, please. :flushed:

(Kirk Wolak) #17

Even where they write “starvation” ketosis is (IMO) ridiculously negative sounding.

what they meant was: “Quickly Depleting Fat Stores!” (And if you are an HEALTHY ATHLETE, or really LEAN, then you shouldn’t be here, or go here carefully)

I’ve been well above 5 with fasting… Never double digits, and my high ketones are always with LOW Glucose…


This is my problem. I’ve called multiple Doctors trying to find one that will support Keto. None will tell me. They insist I must make an appointment and waste my money and time. My current doctor does not support keto. Has anyone found a doctor who does? If so any tips?

(UsedToBeT2D) #19

You do not need a doctor that supports Keto…just play dumb to their questionable advice, and have them do what you tell them, as far as medications and tests.

(Bob M) #20

If insurance covers it, have him get a CGM (continuous glucose monitor) for a while, even 1-2 months. That should (1) help put you at ease, (2) help him with medication, as he can see whether he gets low blood sugar, (3) help him see what foods might affect him.

I note that I have a lot of issues with the famous graph Paul referenced above. However, my issues mainly concern the low end (<0.5mmol/l) of the x axis, not the high end.